Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

Block, Geoffrey A.; Martin, Kévin; Francisco, Ángel; Turner, Stewart A.; Avram, Morrell M.; Suranyi, Michael; Hercz, Gavril; Cunningham, John A.; Abu‐Alfa, Ali K.; Messa, Piergiorgio; Coyne, Daniel W.; Locatelli, Francesco; Cohen, Raphael M.; Evenepoel, Pieter; Moe, Sharon M.; Fournier, A; Braun, J.; McCary, Laura C.; Zani, Valter J.; Olson, Kurt; Drüeke, Tilman B.; Goodman, William G.

doi:10.1056/nejmoa031633

Cited by 1,032 publications

(865 citation statements)

References 35 publications

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“…These positive data were supported and reinforced by a report that combined two major Australian, European, and United States phase 3 trials (42). Patients who had SHPT and were undergoing dialysis were treated with standard-of-care therapy (vitamin D analogues and/or phosphate binders) or standard-of-care therapy plus cinacalcet (30 to 180 mg/d) for a total of 26 wk (12-wk titration phase and 14-wk efficacy assessment phase).…”

Section: Impact Of Treatment With Calcimimetics On Hptmentioning

confidence: 63%

Impact of Treatment with Calcimimetics on Hyperparathyroidism and Vascular Mineralization

Francisco¹,

Piñera²,

Palomar³

et al. 2006

Journal of the American Society of Nephrology

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Soft tissue calcification that involves primarily the medial portion of the arterial vasculature is a widely recognized and common complication of chronic kidney disease Vascular calcification (VC) causes increased arterial stiffness and contributes to the high cardiovascular mortality and morbidity in dialysis patients. The pathogenesis of VC is complex and includes factors that promote calcification and others that inhibit calcification. Studies in dialysis patients have shown a correlation between VC and a number of uremia-related factors. Overall, abnormalities in calcium and phosphate metabolism, such as hyperphosphatemia and a raised serum calcium-phosphorus product traditionally have been thought of as important determinants in patients with chronic renal failure. Common therapeutic interventions in secondary hyperparathyroidism have come under scrutiny for associations with the development of VC. Calcimimetics provide a means of controlling serum levels of parathyroid hormone in secondary hyperparathyroidism without increasing the calcium-phosphorus product and, more important, may lower the risk for VC in these patients.

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Section: Impact Of Treatment With Calcimimetics On Hptmentioning

confidence: 63%

Impact of Treatment with Calcimimetics on Hyperparathyroidism and Vascular Mineralization

Francisco¹,

Piñera²,

Palomar³

et al. 2006

Journal of the American Society of Nephrology

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“…Generally, PTX is a valuable option in any patient diagnosed with renal HPT; however, the majority of patients may be controlled medically. Successful medical treatment can be achieved with phosphate binders, calcium supplements, active vitamin D analogues and cinacalcet which alter calcium receptor sensitivity of parathyroid glands and kidneys, thus reducing PTH secretion and restoring calcium-phosphorus homeostasis [17][18][19][20] (evidence level (EL); recommendation grade (RG) EL 1a; RG A) [21]. Cinacalcet is stated to reduce mortality in renal HPT patients, while contradictory reports acclaim a lack of patient-relevant outcomes improvement and relevant side-effects in patients on dialysis [22].…”

Section: Resultsmentioning

confidence: 99%

“…Cinacalcet is stated to reduce mortality in renal HPT patients, while contradictory reports acclaim a lack of patient-relevant outcomes improvement and relevant side-effects in patients on dialysis [22]. Initial randomized controlled studies (RCT) with placebo arm recognized that cinacalcet could cause severe hypocalcaemia (<7.5 mg/dl) in up to 5 % of patients requiring oral calcium and/or vitamin D substitution [17]. Even more patients (35-45 %) experience digestive intolerance, in 8-15 %, requiring to terminate treatment [19,20,23] (EL 2b; RG B).…”

Section: Resultsmentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

108

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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“…Recent data, however, suggest that these goals often are not met (29,40) with conventional hemodialysis. Newer vitamin D analogues (41), calcimimetics (42), and noncalcium-based phosphate binders (43)(44)(45) all are welcome developments in the effort to improve metabolic control; however, failure to achieve mineral metabolism goals remains a significant problem (46). A consensus on how best to improve achievement of K/DOQI goals for mineral metabolism has not yet been reached in the context of conventional hemodialysis.…”

Section: Mineral Metabolism: How To Get Control?mentioning

confidence: 99%

Left Ventricular Hypertrophy

Achinger

Ayus

2006

Journal of the American Society of Nephrology

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Cardiovascular disease occurs in ESRD patients at rates that are far higher than is seen in the general population, and cardiovascular deaths account for the majority of deaths among dialysis patients. Abnormal mineral metabolism is a novel cardiovascular risk factor among dialysis patients. Recently published results demonstrated that even with good control of BP and anemia, conventional hemodialysis is associated with significant left ventricular hypertrophy (LVH); however, daily hemodialysis was associated with a significant reduction in LV mass index (LVMI). Furthermore, it was shown that control of serum phosphorus correlates with the reduction in LVMI. These data suggest a novel mechanism for the deleterious effect of elevated serum phosphorus on cardiovascular outcomes among hemodialysis patients: LVH. Other investigators have noted an association of hyperphosphatemia and LVH; however, this study was the first to demonstrate that improvement in serum phosphorus is associated with reduction in LVM. In addition, it is shown that daily hemodialysis is an effective modality in improving serum phosphorus through significantly improved phosphorus removal. Elevated serum phosphorus leads to vascular calcification, which can lead to LVH by decreasing vascular compliance. However, our study showed an improvement in LVMI during a 12-mo period. Because vascular calcification is unlikely to remit over this time period, it is proposed that serum phosphorus has a reversible, cardiotoxic effect that leads to LVH that can be reversed successfully with good control of serum phosphorus.

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Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

Abstract: Cinacalcet lowers parathyroid hormone levels and improves calcium-phosphorus homeostasis in patients receiving hemodialysis who have uncontrolled secondary hyperparathyroidism.

Cited by 1,032 publications

References 35 publications

Impact of Treatment with Calcimimetics on Hyperparathyroidism and Vascular Mineralization

Impact of Treatment with Calcimimetics on Hyperparathyroidism and Vascular Mineralization

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Left Ventricular Hypertrophy

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